Leave this field blank Name of Membership Group Group Member Number Address where group meets Suburb Postcode Postal Address Suburb Postcode Name of President Phone Number Email address Name of Secretary Phone Number Email address Main Contact Name Main Contact Phone Number Email address for Group Does your group have a social media page or website? For example Facebook or Instagram. Yes No Please provide the link here: https:// Do you wish to take out Insurance with Victorian Quilters Inc. for your Group? Yes No The insurance broker needs a breakdown of the ages of the members in your group. Please advise details below. How many of your members are aged : Under 18 Aged 18 - 74 Aged 75 - 84 Over 85 How many Members do you have in total in your Group? 1 - 25 26 - 50 51 - 100 101 - 200 201 - 300 301 - 400 401 & over The Renewal Fee for a Group Membership with 1 - 25 members is $170, which includes a base annual renewal fee of $60. The Renewal Fee for a Group Membership with 26 - 50 members is $220, which includes a base annual renewal fee of $60. The Renewal Fee for a Group Membership with 51 - 100 members is $350, which includes a base annual renewal fee of $60. The Renewal Fee for a Group Membership with 101 - 200 members is $500, which includes a base annual renewal fee of $60. The Renewal Fee for a Group Membership with 201 - 300 members is $555, which includes a base annual renewal fee of $60. The Renewal Fee for a Group Membership with 301 - 400 members is $650, which includes a base annual renewal fee of $60. The Renewal Fee for a Group Membership with 401 + members is $710, which includes a base annual renewal fee of $60. The annual renewal fee for Group Membership without insurance is $60. Please forward payment by one of the methods listed below. Will you be sending payment by cheque or bank transfer? Cheque Bank transfer Please send cheque made payable to Victorian Quilters Inc. to:Victorian Quilters Inc.c/- 5 Robinson Rd,Kooroocheang VIC 3364with your Group name in a letter, or a copy of the pdf you will receive after submitting this form. Please deposit to :Victorian Quilters Inc.BSB 033 180A/C 302487For the Reference, please use Your Group Name and/or Group Number Our group is able to sell a book of 10 Raffle tickets @ $2 each for the Showcase Raffle Quilt. YES NO Please notify Victorian Quilters Inc. of any changes to the details above using the Contact form on the website. Validate your submission Submit
